Group A7----ICM II CTG Questions for 4/10/14

Renal Question
A 62-year-old man presents to the emergency room with an acute myocardial
infarction. Twenty-four hours after admission to the cardiac intensive care unit, he
develops oliguria. Laboratory tests show that his serum BUN is 59 mg/dL and his
serum creatinine is 6.2 mg/dL. Renal biopsy reveals necrosis of the proximal tubules
and thick ascending limb of Henle's loop. Which of the following would you most
likely observe on a microscopic examination of this patient's urine?
1.
2.
3.
4.
5.

White blood cell casts

Fatty casts
Muddy brown casts
Hyaline casts
Broad waxy casts

Answer: Muddy brown casts

Muddy brown casts are part of the classic presentation of ATN.
ATN is defined as acute suppression of renal function developing over 24 hours, and
is caused by ischemic or toxic damage to the kidney. ATN is the most common cause
of acute renal failure and is accompanied by anuria or oliguria. As a result of his
myocardial infarction, this patient developed decreased cardiac output, resulting in
ischemic ATN. Ischemic ATN manifests most commonly in the straight portion of the
proximal tubule and in the thick ascending limb. This distribution of ischemic damage
is due to the high metabolic activity of these tubular cells combined with the
relatively low blood supply to the location of these tubular segments within the outer
medulla.

Female Repro/Breast
A 48 year old woman comes to the physician because of blood-tinged discharge from
one nipple. Physical examination shows a small, palpable subareolar tumor. The
tumor is surgically resected. Which of the following features on histologic
examination would indicate that this tumor is malignant?
A) Apocrine Metaplasia
B) Presence of both epithelial and myoepithelial cells
C) Small size of tumor
D) Presence of fibrovascular projections
E) Presence of only epithelial cells
Answer: E, Presence of only epithelial cells.
A Papillary carcinoma of the breast presents much like a intraductal papilloma bloody nipple, with fibrovascular projections. The key difference is on histological
exam is that a Papilloma has epithelial AND myoepithelial cells (CHOICE B), while a
papillary carcinoma has only epithelial cells. They both have fibrovascular projections
(Choice D). Both malignant and benign tumors can be small (Choice C). Other
features which favor carcinoma are: cytologic atypic, abnormal mitoses, and cribiform
growth pattern. Apocrine Metaplasia is seen in benign fibrocystic changes and has no
increased risk for a Carcinoma (Choice A).

Male Repro
Mike Hunt is a 26 year old male athlete who runs cross country for his college. One
week ago he presented to his doctors office with painful swelling in his scrotum. He
was referred to the urologist but never showed up. What type of infarct will need to
ovoided if this complication is fixed?
A) White
B) Red
C) Fat
D) Yellow
E) Subepithelial Infart

Explanation:
The answer is red Infarct B. Reperfusion injury of the testes will cause a red
infarct, a clot in the vein can also cause a red infarct. In testicular torsion, hours
may pass before the testicle can be surgically repaired, or even days if the patient
delays treatment or delays seeing a physician.
A a white infarct is seen in infarction of the renal arteries and in infarction of the
heart.
C- There is no such thing as a fat infarct, however there is fat necrosis of tissues
such as the pancreas.
D- There is no such thing as a yellow infarct, however white infarcts can have a
yellowish appearance.
E There is no such thing as a Subepithelial infarct.